ABSTRACT
Teenage pregnancy is a social problem worldwide. Literature
has reported that teenage pregnancy has adverse maternal and neonatal outcomes.
This study sought to assess the obstetric and perinatal outcomes of pregnancy
among teenagers in the Cape Coast Metropolis.This retrospective case control
study was conducted among 1,006 respondents made up of 505 teenagers (case) and
501 adults (control). Secondary data were collated from the obstetric
registers, client folders and labour ward report books of three hospitals in
the Cape Coast Metropolis.The researcher used frequencies, percentages, graphs,
Chi-square tests and odds ratios in the SPSS to analyse the data. It was found
that the mean age of the teenage mothers was 16. 9 years whiles that of the
adults was 26.9 years. The rate of antenatal attendance was high among the
teenagers than the adult. The teenagers had a lower risk of caesarean section
delivery and a higher rate of spontaneous vaginal delivery as compared with the
adult (P< 0.001). The rate of low birth weight babies born to the young
mothers was significantly higher than that of babies born to the adult mothers
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CHAPTER ONE
INTRODUCTION
Background to the Study
Teenage pregnancy has traditionally
been considered high-risk pregnancy, especially in developing countries. The
underdeveloped pelvis in younger teenage mothers can mean that they have more
difficulties in childbirth than adults Sulaiman, Othman, Razali, &Hassan,
(2013). Lot of research has been done regarding the risk factors, complications
and outcome of teenage pregnancy, but studies specifically on obstetric and
perinatal outcomes among teenage pregnant mothers, are quite scarce in our
country.(Shaikh, Shaikh, Shaikh &Isran, 2012).
Teenage pregnancy is a social
problem worldwide (Derme, Leoncini, Vetrano, Carlomagno & Aleandri (2013).
It is estimated that 16 million girls between the ages of 15 and 19 give birth
every year, with 95% of these births occurring in developing countries. This
number represents 11% of all births worldwide (WHO, 2009). Seven countries
India, Bangladesh, Brazil, the Democratic Republic of Congo, Ethiopia, Nigeria
and the United States of America account for half of all teenage births: (WHO,
2009). Pregnant teenagers are generally considered to be a high-risk
obstetrical population, although the published evidence is inconclusive and
contradictory. It has been postulated that if there is an increased risk, it
may be because of an inherent biological disadvantage of childbearing during
the teenage period (Kirchengast& Hartmann, (2003). Acording to Al-Ramahi
and Saleh (2006) teenagers are a socially and economically
disadvantaged group.There are confounding behavioural factors that are more
prevalent among adolescents, such as substance use and inconsistent prenatal
care.
Teenage pregnant girls showed
increased rates of unfavourable obstetric outcomes, as compared to their older
counterparts. Teens showed a two-fold increase in the risk of experiencing
pregnancy-related hypertension, as well as an increased rate of low birth
weight infants (Pérez-López, Chedraui, Kravitz, Salazar-Pousada,& Hidalgo,
2011). According to Pérez-López et al. (2011), no significant difference was
observed between primi-gravid teens and older women, for most antenatal
complications, including hypertension, placental abruption, placenta praevia,
premature rupture of membranes, urinary tract infections and anaemia.
Several researchers (Galvez-Myles
& Myles, 2005; Yildirim, Murat Inal,& Tinar, 2005; Al-Ramahi,&
Saleh, 2006; Gilbert,Jandial,Field,Bigelow, &Danielsen, 2004; Gortzak-Uzan,
Hallak, Press, Katz, & Shoham-Vardi, 2001) report that adolescents,
compared with older women, are at increased risk of adverse pregnancy
outcomes.Preterm delivery, low birth weight (LBW) infants, small for
gestational age (SGA) infants, and late foetal demise have been reported.
Increased risk of anaemia, urinary tract infections, and sexually transmitted infections
has also been reported among adolescents. According to Yadav, Choudhary,
Narayan and Mandal (2008), obstetric outcome of teenage pregnancies have a low
rate of caesarean section.
In a study in Nigeria, Ezegwui,
Ikeakoand Ogbuefi
(2012),reported that majority of the teenagers (78.3%) were nulliparous,
they found that 19% delivered
through caesarean section, cephalo-pelvic disproportion as an indication for
caesarean section (9.4%), preterm delivery (18.9%), low birth weight (23.0%),
episiotomy (61.7%), and instrumental delivery (6.8%). Another study revealed a
significant increase in preterm delivery, LBW and neonatal mortality when age
at first childbirth falls below 16 years (Phipps & Sowers, 2002). The Ghana
Demographic and Health Survey revealed that births to young mothers (under age
20 years) continue to be at a higher risk of dying than those of older mothers
(Ghana Statistical Service, 2009). This study seeks to assess obstetric and
perinatal outcomes of pregnancy among teenagers.
Statement of the Problem
Teenage pregnancy is a major
contributor to maternal and child mortality, and to the vicious cycle of
ill-health and poverty (WHO, 2012). The Global strategy for women and child
health, stress the importance of addressing the health and welfare needs of
teenage girls in order to achieve the fifth Millennium Development Goal on
maternal mortality reduction (WHO, 2012). Despite declines since 1991, the teen
birth rate in the United States remains as much as nine times higher as in
other developed countries (Ventura,& Hamilton, 2011). In a multi-ethnic
American study, teenage pregnant girls showed increased rates of unfavourable
obstetric outcomes, as compared to their older counterparts. Teens showed a
two-fold increase in the risk of experiencing pregnancy related hypertension,
as well as an increased rate of low birth weight infants (Pérez-López et al.,
2011). Teenagers are considered high risk due to the physical immaturity
of their reproductive system, which may not be able to withstand the strains of
pregnancy and childbirth (Yeboah, 2012).
Literature has revealed that
Ghanaian adolescents are highly sexually active and begin sexual activity at an
early age (Ghana Statistical Service, 2004). As indicated by Ghana Demographic
and Health Survey, 9.0% of women and4.0% of men reported having sexual
intercourse by age 15. However, by age eighteen, 48.0% of women and 25.0% of
men have had sexual intercourse (Ghana Statistical Service, 2004). These
figures imply that some proportion of first sexual experience occurs during
teenage period which may lead to teenage pregnancy. The GDHS, again indicated
that at national level, some 14.0% of 15-19 years old adolescents are pregnant
or are already mothers (Ghana Statistical Service, 2004). The Ghana Demographic
and Health Survey revealed that births to young mothers (under age 20 years)
continue to be at a higher risk of dying than those of older mothers (Ghana
Statistical Service, 2009).Statistics by the Ghana Health services has revealed
that about 750,000 teenagers between the ages of 15and 19 became pregnant in
2013. Close to 14,000 teenagers in the Central Region got pregnant in 2013,
indicating a tremendous 62% increase in the region over the previous years
(Modern Ghana, 2013). Report of the Family health Division of the Ghana Health
service revealed that Central Region recorded teenage pregnancy rate of 15% in
2013, 14.8% in 2014 and 14.5 in 2015. These rates are higher than the national
average of 12.3, 12.1 and 12.1 respectively. This implies that teenage
pregnancy is common in Central Region.Literature on outcome of pregnancy among
teenagers is limited in Ghana. Many studies have reported on teenage pregnancy
and pregnancy outcomes in relation to other conditions in Cape Coast and Ghana (Yeboah,
2012; Siakwa et al., 2014a; Siakwa et al., 2014b; Siakwa, Kpikpitse, Wisdom,
& Asamoah , 2016). Their studies did not specifically look at teenage
pregnancy outcomes. The purpose of this study was to assess the obstetrical and
perinatal outcomes among teenage pregnant mothers in the Cape Coast Metropolis.
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